Past Students

Amrita Daftary, PhD
Supervisor: Liviana Calzavara
Year: 2011
Programme: Health and Behavioural Sciences
Thesis Title: Integrating patients into integrated care: perspectives from individuals coinfected with tuberculosis and HIV
Abstract: Background:Tuberculosis (TB) and human-immunodeficiency virus (HIV) infections are intertwined through complex biological and social pathways that affect over one million people worldwide. Mitigation of the co-epidemic is undermined by a failure to integrate TB and HIV healthcare services as a result of critical clinical, operational and social challenges. The social challenges of TB/HIV coinfection and integrated care are least understood.Objectives:This research examines the social contexts of TB/HIV illness and related healthcare from the perspective of patients coinfected with TB and HIV.Methods:The study was set within a constructivist-interpretivist theoretical framework. Non-participant field observations and semi-structured in-depth interviews were held with 40 coinfected adults (24 women, 16 men) and 8 healthcare workers at 3 ambulatory clinics in KwaZulu-Natal, South Africa, providing varying models of TB and HIV care. Subjective meanings of illness and healthcare were analyzed in relation to patients’ social contexts.Findings and Interpretations:Coinfection exposes patients to a double and unequal form of social stigma against TB and HIV. Affected individuals construct dual identities and negotiate selective disclosure of TB over HIV in order to manage this double stigma. Their experiences with stigma are bound by sociostructural and gendered inequalities, and mediate their decisions to disclose, access and adhere to medical care. Coinfection also exposes patients to pluralistic, disparate and fragmented healthcare. Experiences with stigma and with distinct cultures of TB/HIV care affect their decisions for integrated care. While integration may allow for some technical and clinical efficiency, it may also heighten some patients’ social burden of illness as a result of HIV disclosure and stigmatization.Conclusion: Integration efforts need to consider the social contexts of TB/HIV, the social consequences of patients’ health decisions, and the paradigms within which such efforts are set in the design and execution of successful interventions.

 

David Ip, MSc
Supervisor: Liviana Calzavara
Year: 2012
Programme: Epidemiology
Thesis Title: Condom Use Among High-Risk Youth in Ontario
Abstract: Objective:To examine the past-year prevalence and frequency of condom use and to identify correlates of condom use among young, unattached heterosexual Ontarians.Methods:Descriptive statistics and multiple logistic regression were used to analyze the 1996/97 Ontario Health Survey (OHS), a cross-sectional, random digit-dialling (RDD) survey of 36,892 Ontario residents of households with a telephone line.Results: Between 1996 and 1997, 61.3% (95% CI=58.5%-64.1%) of the study sample (aged 15-44, n=1,949) reported consistent (always) condom use and 11.8% (95% CI=10.2%-13.5%) reported never using condoms. Significant correlates included, for both sexes, health planning region, age, ethnic origin, and type of smoker; for females only, socio-economic status, age at first sexual intercourse, and past-month oral contraceptive use; and for males only, number of past-year sexual partners, HIV testing history, and past-year frequency of religious attendance.Conclusions: Findings constitute a cross-sectional component for examining the long-term trend of condom use in Ontario.

 

Anthony Lombardo, MA, PhD
Supervisor: Ted Myers
Year: 2009
Programme: Health and Behavioural Science
Thesis Title: Sex and Cyberspace: The Internet in the Sexual Lives of Men Who Have Sex With Men
Abstract: The Men, Internet, and Sex with Men Study was a qualitative inquiry into how men who have sex with men (MSM) use the Internet in their sexual lives. The study responds to calls for HIV prevention to become more resonant with men’s online experiences. Men’s use of the Internet in their sexual lives was explored through structural interactionist and social risk theories. The study was a focused ethnography, drawing on semi-structured interviews with 23 MSM from the Greater Toronto Area. The sample included men aged 20 to 61, from a variety of sexual orientations (gay, bisexual, and heterosexual) and HIV statuses. Data analysis focused on the contextual aspects of men’s use of the Internet for sexual purposes and their sexual risk behaviour. This study focused on how men’s use of the Internet for sexual purposes was situated within and influenced by the contexts of their use. The participants’ online experiences were socially-situated from the outset: men saw the Internet as a “solution” to challenges in their sexual lives; their online interactions were structured by online rules of engagement and discourse from the offline gay community; and their sexual risk behaviour was mediated by social context and sexual interactions. The participants’ stories revealed the existence of an online subculture for sex seeking. Men also talked about the links between their online and offline experiences, where the Internet played a role in developing their sexuality but could also foster isolation and addiction. The men emphasized the importance of online HIV prevention and offered suggestions on how prevention more generally might be improved. The Internet holds both promise and pitfalls for HIV prevention. The findings from this study underline the need for prevention efforts that focus on individual- and structural level prevention which can respond to men’s experiences both online and offline.

 

Wendy Bhanich-Supapol, PhD
Supervisor: Robert Remis and Peggy Millson
Year: 2009
Programme: Epidemiology
Thesis Title: The impact of GBV-C coinfection on mother-infant HIV transmission and natural history of HIV infection in infants
Abstract: GBV-C is a common, apathogenic virus that can inhibit HIV replication in vitro. Persistent coinfection with GB virus C (GBV-C) has been associated with improved survival among HIV-infected adults while loss of GBV-C viremia has been associated with poor survival. If GBV-C does inhibit HIV replication, it is possible that GBV-C infection may prevent mother-to-child-transmission (MTCT) of HIV. This study investigated whether maternal or infant GBV-C infection was associated with MTCT of HIV infection. We also determined the rate and correlates of MTCT of GBV-C and the prevalence and correlates of GBV-C infection among HIV-infected and HIV-uninfected women. The study population consisted of 1,783 pregnant women from three Bangkok perinatal HIV transmission studies (1992-2004). We tested plasma collected at delivery for GBVC RNA, GBV-C antibody, and GBV-C viral genotype. If maternal GBV-C RNA was detected, the four- or six-month infant specimen was tested for GBV-C RNA. Rates of MTCT of HIV in GBV-C-infected and GBV-C-uninfected women and infants were compared using multiple logistic regression. The prevalence of GBV-C infection (i.e. presence of RNA or antibody) was 33% among HIV-infected women and 15% among HIV-uninfected women. Prevalence of GBV-C viremia (RNA) was 20% among HIV-infected women. Forty-one percent of GBV-CRNA- positive women transmitted GBV-C to their infants. Only two of 101 (2.0%) GBV-C-RNA-positive infants acquired HIV infection compared to 162 (13.2%) of 1,232 of GBV-C-RNA-negative infants (p<0.0001). This association remained after adjustment for maternal HIV viral load, antiretroviral prophylaxis, CD4+ count and other covariates. MTCT of HIV was not associated with presence of maternal GBV-C RNA or maternal GBV-C antibody. Maternal receipt of antiretroviral therapy was associated with increased MTCT of GBV-C as was high maternal GBV-C viral load, vaginal delivery, and absence of infant HIV infection. GBV-C infection in the mother was independently associated with more than one lifetime sexual partner, intravenous drug use, and HIVinfection. GBV-C infection in mothers was associated with both sexual and parenteral risk behaviours. Infant but not maternal GBV-C infection was significantly associated with reduced MTCT of HIV and maternal antiretroviral therapy was associated with increased MTCT of GBV-C; the mechanisms for these associations remain unknown.

 

Jeffrey P. Aguinaldo, MA, PhD
Supervisor: Ted Myers
Year: 2007
Programme: Social Science and Health
Thesis Title: Gay men’s health: A social constructionist analysis of academic literature and talk about the health of gay men
Abstract: At the close of the third decade of the AIDS epidemic, there is renewed interest in the once dormant field of gay men’s health.  Resurfacing in the 1990s, the term “gay men’s health” has cropped up in numerous arenas including government policy, academic literature, popular press, and community organising.  In this dissertation, I explore the social construction of gay men’s health.  I specifically draw on gay men’s health literature and interview talk not as a resource for what they can tell us about the health of gay men, but as data.  Using social constructionism and discourse analysis, I analyse these data to explore (a) how the disciplinary practices of gay men’s health are constructed in the academic literature and (b) how the health of gay men is constructed in talk. The findings are divided into two sections.  In Part I, I explore how the health of gay men is constructed in the literature and how these constructions promote particular ideologies, as well as theoretical, and epistemological interests.  First, I explore the types of claims about the health of gay men reported in the literature and how they reveal a firm commitment to positivist-empiricism and the scientific method. Second, by highlighting constructions of gay oppression, gay oppression as a determinant of health, and health interventions directed toward gay men, I show how gay men’s health is fundamentally individualistic.  In Part II, I report on the findings from analyses of interview talk about the health of gay men.  In particular, I explore two salient accounts in gay men’s health:  substance abuse and HIV/AIDS.  I show that the interviewees harness these accounts to manage their accountability for engaging in the very behaviours that gay men’s health seeks to prevent.  I also show that the interviewees are explicitly concerned with avoiding individualised explanations for their health.  In the conclusion, I summarise the findings in relation to the research questions and discuss the implications of my research for constructionist and discursive research, gay men’s health, and gay oppression, and I offer suggestions for future research in gay men’s health.

 

Andrea Anonychuk, MSc
Supervisor: Liviana Calzavara
Year: 2005
Programme: Health and Behavioural Sciences
Thesis Title: Stressful Relationship Events and HIV-risk Behavour among Men who have Sex with Men:  Results from the Polaris HIV Seroconversion Study
Abstract: Objectives:  To describe stressful relationship events and determine their impact on high-risk sex among gay and bisexual men.Methods:Secondary data analysis was conducted using a sub-sample of 208 HIV-positive and HIV-negative men participating in a longitudinal open-cohort. Bivariate and multivariate analytical techniques were used.Results:Thirty-six percent experienced a stressful relationship event within a six-month period including the ending of a romantic relationship (23%), increased arguments with a partner (21%), and finding out a partner’s affair (7%). HIV-negative men, illicit drug users, and men who experienced increased arguments were more likely to engage in unprotected intercourse with their partners. The impact of stressful relationship events on high-risk sex was greater in younger men.Discussion: Couples who experience relationship stress may be at risk for HIV transmission given that they are more likely to engage in high-risk sex. Prevention efforts should take these broader social and psychological issues into account.

 

Sandra, Bullock, MSc, PhD
Supervisor: Ted Myers
Year: 2001
Programme: Social Science and Health
Thesis Title: About last night: Dates, drinks and sex. A study of the association between alcohol use and sexual activity among heterosexuals, including sexual behaviours at high risk for the transmission of STDs and HIV
Abstract: This thesis examined whether there was an association between alcohol use and participation in unprotected intercourse (UI), the individual and situational modifiers of the relationship and the extent to which theoretical perspectives (personality, disinhibition and self-handicapping) explained the association.  A convenience sample included 122 participants who were aged 19-35, unmarried, nonmonogamous, and had consumed alcohol and had sex once per week on average. Background data were collected with a face-to-face interview, and participants used daily quantitative logbooks to record all date, drinking, and sexual events over an eight-week period. Within-subject, event-based data were analyzed using multivariate GEE.  1,173 sexual events were reported. Participants drank prior to 43.2% of the events and used condoms in 40.7% of the intercourse events. Individuals were more likely to use condoms with first-time (OR = 4.2) and repeat (OR = 2.6) partners than with primary/committed partners (p < 0.001). Controlling for individual and contextual factors in sexual events with primary partners, alcohol inebriation was associated with UI (OR = 2.32, p < 0.01); however, with “mastery” considered, drinking was no longer significant.  With first-time partners, individuals with low impulse-control were more likely to have UI (OR = 1.20, p < 0.01). A high “self-handicapping” score indicated that a participant believed: in the disinhibition thesis; that they had less responsibility for actions when drinking; and that their peers supported condom use and would disapprove if they had UI. “Self-handicapping” mediated the association between drinking and UI with first-time partners. Individuals prone to “self-handicapping” had a greater probability of UI in events when drinking; whereas, individuals not prone to “self-handicapping” were more likely to be safer when drinking.  Little evidence was found for the physiological version of the disinhibition hypothesis linking alcohol to UI. The importance of the personality factors suggests new areas of skill development that, if altered, may lead to both decreased drinking and UI. Issues specific to drinking context, partner type, and personality must be considered in order to tailor health promotion messages and programs. Messages suggesting that people are not rational or in control when inebriated may lead people to avoid taking responsibility for their behaviour, and keep them from practicing safer sex.

 

Naushaba Degani, PhD
Supervisor: Peggy Millson
Year:
Programme: Institute of Medical Sciences
Thesis Title:
Abstract:

 

Dale DeMatteo, MSc
Supervisor: Liviana Calzavara
Year: 2002
Programme: Social Science and Health
Thesis Title: The Experiences and Decision-making of Pregnant Women Testing Positive for HIV in Ontario Following the Introduction of Voluntary Antenatal HIV Screening
Abstract: Purpose:To document the experiences of Canadian women testing positive for HIV in pregnancy.Methods:The study combines social phenomenology and critical analysis. Twelve women from four provinces participated in semi-structured interviews. Data analysis followed Colaizzi’s method. The “zoom” approach (situating the micro world of individuals with the broader macro environment) served as vehicle for exploring the ethical/social implications of public policy.Findings:The essential meaning of a diagnosis of HIV in pregnancy is best understood within the framework of two interrelated relationships–between mother/fetus and doctor/patient viewed through a broad contextual lens.Conclusion: The findings indicate a critical need for broad discussion of the social implications of pregnancy HIV screening for women and families.

 

Emma Haydon, MSc
Supervisor: Peggy Millson
Year: 2005
Programme: Social Science and Health
Thesis Title: Homemaking/Making Home: The Domestic Lives of Women Living in Poverty and Using Illicit Drugs
Abstract: The ‘home’ is a contested site for many women. Women living in poverty and using illicit drugs are largely excluded from participation in traditional ‘home-based’ gender roles of wife and mother, due primarily to economic disadvantage. Using grounded theory methodology within a poststructuralist feminist framework, I conducted in-depth, open-ended interviews with 11 women living in the Toronto area.  Through the data analysis process, I developed a substantive theory of ‘making home’ for women living in poverty and using illicit drugs based on emerging concepts. The central concept of making home is a continual process of learning about and interacting with the environment. Participants developed different meanings of home grounded in their particular experiences and knowledge.  The women I interviewed were very mobile and experienced constant change with regards to home. The theory challenges existing definitions of homelessness. The theoretical, practice, and policy implications of the findings are discussed in detail.

 

Jill Parsons, MHSc
Supervisor: Peggy Millson
Year: 2007
Programme: Epidemiology
Thesis Title: Self-Reported Continuation of Injection and Psychiatric Severity Ratings of Participants in a Low-Threshold Methadone Maintenance Program.
Abstract:

 

Nancy Ramuscak, MSc
Supervisor: Liviana Calzavara
Year: 2002
Programme: Epidemiology
Thesis Title: Drug use in prison: How incarceration affects drug use patterns
Abstract: Objectives:To describe changes in drug use among male inmates during incarceration; and investigate predictors of continued drug use inside.Methods:Secondary data analysis was completed using a 1996-97 study of inmates in six provincial correctional centres across Ontario. Analysis was restricted to males incarcerated for 1+ months (n = 433). Bivariate and multivariate analytical techniques were used.Results:Seventy-three percent used drugs outside and 52% used drugs inside. Significant decreases in the use of all drugs inside were reported, along with significant reductions in the frequency of use (except tranquillizers). Significant changes in drug use pattern occurred. Predictors of continued drug use were: cannabis use, polydrug use, and higher frequency of drug use outside; and longer sentence length.Conclusions: Drug use continues to occur in prison, although at a reduced frequency. Predictors of continued drug use can help focus drug treatment programs towards those who are most likely to receive benefit.

 

Carol J. Strike, MSc, PhD
Supervisor: Ted Myers
Year: 2000
Programme: Social Science and Health
Thesis Title: Organizational response to illegitimacy: The case of needle exchange programs in Ontario
Abstract: Needle exchange programs (NEPs) are controversial Human Immunodeficiency Syndrom. (HIV) prevention programs. This study focussed on how NEPs in Ontario identify and respond to illegitimacy and the impact of responses on service delivery. Neo-institutional theory and the strategic response literature were used as frameworks.  Semi-structured, qualitative interviews were conducted with 59 NEP workers, managers and Medical/Executive Directors. Data were transcribed and entered into Ethnograph. Data were coded based on theoretical and emergent concepts. Data analysis involved an iterative process of comparing data with theory and theory with data.  Results show that NEPs are situated in an environment dominated by the discourses of abstinence and criminal justice. NEP clients, injection drug users (IDUs) are a highly stigmatized group believed to be undeserving of publicly funded disease prevention programs. As a result, NEPs, are often regarded as illegitimate. NEPs use varied strategies to overcome the perception of illegitimacy. NEPs try to prevent labelling as illegitimate by demonstrating conformity with institutional expectations using strategies such as imitation. Other NEPs, seek external endorsements. NEPs also try to co-opt institutional authorities and manipulate institutional demands.  However, attempts to prevent illegitimacy are not always successful. Questions about the effectiveness of needle exchange, behavioural goals, and the ‘worthiness’ of clients represent threats to NEP legitimacy. Responses vary from attempts to demonstrate conformity with expectations to negotiation, avoidance, defiance and manipulation of the institutional environment. NEPs also contend with questions about legitimacy from clients. Responses reflect a blend of manipulation of institutional demands and compliance with client demands. In particular, NEPs adopted an outreach model and have redefined the service-provider client relationship. Efforts to redefine this relationship have created opportunities, but also strained the non-judgmental stance espoused by NEPs.  Slowly, NEP workers and managers are trying to influence the social discourse with respect to IDUs and appropriate social responses to drug-related harm. NEPs seek to increase the constituency of individuals who perceive NEPs as legitimate programs and IDUs as valuable members of society. Increased support for NEPs and experimentation with different models of service delivery may increase the potential for HIV prevention in Ontario.